Are natriuretic peptides the compass when navigating diabetes and heart failure?

Around 1500 BC, ancient Egyptians first described diabetes as a rare condition in which a person urinated excessively and lost weight. In approximately 100 AD, the Greek physician Aretaeus first used the term diabetes mellitus to represent the disease causing individuals to have sweet-tasting urine. It was not until 1776 that Matthew Dobson, an English physician, was able to determine the sweet taste was due to the elevated concentration of glucose in the urine.¹ Since 1776, medicine has made great advances in the detection, treatment and monitoring of patients with diabetes, but heart failure (HF) still impacts 22% of patients with diabetes today.² It is time for patients with diabetes to know not only their hemoglobin A1c value, but also their natriuretic peptide value.

The 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure³ divide heart failure into four different stages based on symptoms, structural abnormalities and biomarker findings. Within Stage A, individuals are categorized as “At-Risk for HF,” and patients with diabetes are included. In addition to team-based care, these guidelines recommend natriuretic peptide-based screening may prevent left ventricular dysfunction or new-onset heart failure in at-risk patients. This recommendation associates patients with diabetes to their risk for developing heart failure and highlights the importance of biomarkers and care teams in their management.

Second, a consensus report of the American Diabetes Association (ADA) was published in 2022, emphasizing early identification of heart failure progression. In Heart Failure: An Underappreciated Complication of Diabetes,² the authors recommend checking cardiac biomarkers (NT-proBNP, BNP or hs-cTn) at least annually in order to identify patients moving from Stage A to Stage B heart failure as early as possible. Not only is the goal to detect disease progression early in patients, but the identification of abnormal biomarkers or structural changes enables the care team to adjust medications to optimize cardiovascular benefit and minimize the risk for further progression to symptomatic heart failure.

Last, the ADA highlights the importance of monitoring for heart failure progression in people with diabetes within the updated Standards of Care in Diabetes–2024.⁴ The Standards of Care recommend screening adults with diabetes by measuring a natriuretic peptide due to their risk of asymptomatic cardiac structural or functional abnormalities to facilitate prevention of Stage C heart failure. This guideline marks the first time that use of cardiac biomarkers for heart failure risk prediction–namely the measurement of natriuretic peptides–has been included in the ADA’s official guidelines for diabetes care.

Laboratories may begin to see an influx of cardiac biomarker tests accompanying HbA1c testing based on the updated management guidelines and standards of care concerning heart failure in people with diabetes. Wide adoption of annual cardiac biomarker monitoring when treating people with diabetes may enable more patients to be appropriately monitored and diagnosed with heart failure earlier in the disease course. Knowing the natriuretic peptide value, in addition to the hbA1C, sets the stage for improved treatment, delayed disease progression and the potential for improved quality of life over a longer period of time for these patients.

To learn more about annual cardiac biomarker testing, refer to “Testing for Heart Failure in People with Diabetes: What Do the New ADA Guidelines Mean for Labs?” You can also learn more about Roche’s commitment to Cardiometabolic Health.

References

1. Dobson, M. Nature of the urine in diabetes. Medical Observations and Enquiries 1776;5:218-230.
2. Pop-Busui R, Januzzi J, Bruemmer D et al. Heart Failure: An underappreciated complication of diabetes. Consensus report of the American Diabetes Association. Diabetes Care. 2022;45:1670-1690.
3. Heidenreich P, Bozkurt B, Aguilar D et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure. Circulation. May 2022;145(18):e895-1032.
4. American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: Standards of Care in Diabetes–2024. Diabetes Care 2024;47(Suppl. 1):S179–S218.